Adverse effect of increased left ventricular wall thickness on five year outcomes of patients with negative dobutamine stress.

Thomas F Walsh,W Gregory Hundley,Kerry M Link,Dalane W Kitzman,Timothy M Morgan,William Ntim,Erica Dall'Armellina,Craig A Hamilton,Haroon Chughtai

doi:10.1186/1532-429x-11-25

Abstract

BackgroundTo determine if patients without dobutamine induced left ventricular wall motion abnormalities (WMA) but an increased LV end-diastolic wall thickness (EDWT) exhibit a favorable cardiac prognosis.ResultsBetween 1999 and 2001, 175 patients underwent a dobutamine stress cardiovascular magnetic resonance (DCMR) procedure utilizing gradient-echo cines. Participants had a LV ejection fraction >55% without evidence of an inducible WMA during peak dobutamine/atropine stress. After an average of 5.5 years, all participants were contacted and medical records were reviewed to determine the post-DCMR occurrence of cardiac death, myocardial infarction (MI), and unstable angina (USA) or congestive heart failure (CHF) warranting hospitalization.In a multivariate analysis, that took into account Framingham and other risk factors associated with cardiac events, a cine gradient-echo derived LV EDWT ≥12 mm was associated independently with an increase in cardiac death and MI (HR 6.0, p = 0.0016), and the combined end point of MI, cardiac death, and USA or CHF warranting hospitalization (HR 3.0, p = 0.0005).ConclusionSimilar to echocardiography, CMR measures of increased LV wall thickness should be considered a risk factor for cardiac events in individuals receiving negative reports of inducible ischemia after dobutamine stress. Additional prognostic studies of the importance of LV wall thickness and mass measured with steady-state free precession techniques are warranted.

Highlights

To determine if patients without dobutamine induced left ventricular wall motion abnormalities (WMA) but an increased Left ventricular (LV) end-diastolic wall thickness (EDWT) exhibit a favorable cardiac prognosis
Data from Framingham have shown that increased LV EDWT itself is an independent predictor of cardiac events [8]
This study was performed to determine if the absence of inducible WMA during intravenous dobutamine would be associated with a favorable cardiac prognosis regardless of resting LV EDWT

Summary

Introduction

To determine if patients without dobutamine induced left ventricular wall motion abnormalities (WMA) but an increased LV end-diastolic wall thickness (EDWT) exhibit a favorable cardiac prognosis. If resting LV end-diastolic wall thickness (EDWT) is normal, the absence of dobutamine inducible WMA identifies a group of individuals with a low risk of experiencing future cardiac events [5,6]. Data from Framingham have shown that increased LV EDWT itself is an independent predictor of cardiac events [8] To date, it remains uncertain whether individuals with increased resting LV EDWT and an absence of inducible LV WMA during intravenous dobutamine remain at a relatively low risk of developing a future cardiac event.

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Conclusion